=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508041393
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONTGOMERY RADIOLOGY ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2007
-----------------------------------------------------
Last Update Date | 12/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 CRESSON BLVD SUITE 100
-----------------------------------------------------
City | OAKS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-650-0267
-----------------------------------------------------
Fax | 610-650-0268
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 347279
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15251-4279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-650-0267
-----------------------------------------------------
Fax | 610-650-0268
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRIAN SOLOMON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 610-327-7571
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085N0700X
-----------------------------------------------------
Taxonomy Name | Neuroradiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085U0001X
-----------------------------------------------------
Taxonomy Name | Diagnostic Ultrasound Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2085B0100X
-----------------------------------------------------
Taxonomy Name | Body Imaging Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2085D0003X
-----------------------------------------------------
Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------